A 32-Year-Old Man Comes to the Office Due to an Acute

A 32-year-old man comes to the office due to an acute febrile illness that developed after a deer-hunting trip in Arkansas.  The patient recalls getting tick bites in the woods but initially had no symptoms.  He began experiencing fever, chills, malaise, headache, and myalgia a week after his return.  Physical examination shows a diffuse, maculopapular rash; clear oropharynx; normal lung and heart sounds; and mild, diffuse abdominal tenderness.  Laboratory testing reveals leukopenia, thrombocytopenia, and elevated aminotransferase levels.  Microscopic evaluation of the blood demonstrates mulberry-shaped, intracytoplasmic inclusions in monocytes.  Which of the following is the most likely pathogen responsible for this patient's condition?

A) Babesia microti
B) Borrelia burgdorferi
C) Ehrlichia chaffeensis
D) Francisella tularensis
E) Rickettsia rickettsii

Correct Answer:

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